FORM FOR CLAIM OF BALANCE IN THE SAVINGS BANK ACCOUNT OF DECEASED DEPOSITOR Application for closure of savings/RD/TD/MIS/NSS Account

by Nominee(s)/Legal heirs To, The Postmaster . Sub: Application for withdrawal/closure of account

Sir, I/We . .the nominee(s)/legal heirs of late...the depositor of the SB/RD/TS/MIS/NSS Account No...standing decreased in the said account including interest admissible as per rules. Please find enclosed 1. An original certificate to the death of the depositor. *2. An original certificate in regard to the death of Sri/Smt ...also the nominee(s) appointed by the depositor. *3. Succession certificate/Letter of administration/Probate of will of the decreased depositor issued under the provisions of the Indian Succession Act 1925. 4. Passbook of the depositor. @5. Letter of Indeminity. @6. Affidavit @7. Letter of disclaimer on affidavit. Signature of thumb impression of claimant(s)/Legal heirs Date : Place : Witness 1) Signature.Name and address 2) Signature.Name and address

FOR USE OF POST OFFICE Witness accepted Signature of Postmaster With designation stamp Withdrawal of Rs...(Rs ) is sanctioned with pertains to balance in the account of decreased inclusive of interest admissible as per rules. Signature of PM/SPM With designation stamp RECEIPT TO RESIGNED BY THE CLAIMENT(S) AT THE TIME OF PAYMENT Received cheque No....dated.for a sum of Rs....(......) from..(name of post office) as per details furnished above, in full settlement of our claim. Date :

Place :

Signature/Thumb impression of the claimant(s)